Narcissistic Personality Disorder

What is Narcissistic Personality Disorder?

Narcissistic Personality Disorder (NPD) describes persons with an exaggerated sense of self-importance or uniqueness, and a preoccupation with receiving attention. They will often overstate their own achievements and talents, or focus upon the special nature of their problems. In essence, the narcissist’s fragile self-esteem is revealed by their preoccupation with how others regard them. Features of a narcissistic personality include a preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love. There is also a need for constant attention and admiration, and either a cool indifference or feelings of rage, inferiority, shame, humiliation, or emptiness in response to criticism, indifference of others, or defeat.

What are characteristics?

Entitlement, or the expectation of special favors without assuming reciprocal responsibilities (surprise and anger at people when they do not do what they want).

Interpersonal exploitativeness, or taking advantage of others to indulge their own desires or for self-aggrandizement (a disregard for the personal integrity of others).

Relationships that characteristically alternate between the extremes of over-idealization and devaluation.

Lack of empathy, or the inability to recognize how others feel (unable to appreciate the distress of someone who is seriously ill).

It is important to note that these traits exist on a continuum, with some experiencing milder forms of the disorder and others a more extreme position. The disorder affects men more than women.

What causes Narcissistic Personality Disorder?

NPD is believed to arise primarily from environmental factors, as no specific genetic pattern has been demonstrated. Developmentally, narcissistic traits appear commonly in adolescence. While most people outgrow these traits, those who develop the disorder maintain these characterological issues from adolescence through adulthood.

Narcissism originates from experiences in childhood such as loss of a father figure, an excessively condescending or critical environment, or unpredictable or unreliable caregiving from parents. Other forms of childhood psychological trauma, including physical or sexual abuse increase the risk of developing a personality disorder. Chronic insomnia, overworking, exposure to high levels of stress, substance abuse, medical problems, and difficulties with family or other interpersonal relationships can exacerbate the symptoms of a personality disorder.

Frequently Asked Questions about Narcissistic Personality Disorder

How is it diagnosed?

NPD in adults is recognized by severe disturbances of interpersonal relationships. Younger persons with narcissism display grandiosity, which tends to be less pronounced in adults with “stable” Narcissistic Personality Disorder. Unfortunately, symptoms of this personality disorder tend to be vague and difficult to isolate. For example, lack of empathy and exploitative interpersonal relationships are hallmarks of narcissism, but they can be present with other psychological disorders.

It is primarily characterized by patterns of self-centered and egotistical behavior that negatively impact interpersonal relationships. The dimensionality of narcissistic characteristics (i.e., ranging from normal expressions of an emotion to pathological exaggerations) make diagnosis difficult, as the same emotional issues can be found on a smaller and less intense scale in many normal individuals.

What is the Prognosis?

NPD is generally a life-long disturbance with periods of remission and exacerbation (worsening) dependent on life circumstances. Persons with this disorder rarely enter treatment. Once in treatment. they find it difficult to stay, as they have trouble believing a therapist is really helping them.

Psychotherapy over time, coupled with sleep and stress management, and psycho-education, can address related problems. When a person with NPD develops depression or substance abuse, treatment becomes imperative. Clients who do receive effective treatment will experience significant improvement in their ability to function normally in their daily lives, with improvement in their interpersonal relationships.

What factors can slow recovery?

As discussed, establishing the diagnosis of Narcissistic Personality Disorder may be difficult. Narcissists rarely enter treatment and when in treatment feel they are wasting their time. Depression and substance abuse (especially alcohol, marijuana or cocaine) are also prevalent among persons with this disorder.

Concurrent substance abuse dramatically interferes with effective psychological and medical treatment. Persons with NPD usually have interpersonal problems with family, loved ones, or co-workers. Their impaired social support structure makes it difficult for them to enter or stay in therapy. Persons who are excessively impulsive or self-destructive will require more intensive therapy and may have a slower resolution of their problems.

How Can Friends and Family Help?

Because persons with Narcissistic Personality Disorder have difficulties with interpersonal relationships, family and loved ones may not be interested in participating or helping in their treatment. Family and friends need to educate themselves about Narcissistic Personality Disorder to better empathize and relate to the person who has it. Family can be a valuable resource in monitoring for symptoms as well as maladaptive or dangerous behaviors. They can assist a person with NPD to enter a treatment facility, providing emotional support and financial resources.

When Should a Client enter a treatment center?

Narcissistic Personality Disorder often manifests as serious problems within the family or workplace. In these cases, an intensive treatment program is an appropriate option. Once per week psychotherapy is usually ineffective at managing serious consequences. A treatment facility, like PCH Treatment Center, can be a more effective option than simple outpatient therapy, especially when the client is suffering from other issues such as depression, substance abuse, or estrangement from family or loved ones.

PCH Treatment Center offers a unique way to help people with Narcissistic Personality disorder. Dr. Jeff Ball, the Executive and Clinical Director, has over 25 years of experience in treating personality disorders. He has assembled a highly qualified staff that is familiar with the challenges this disorder presents.

When a Client enters PCH Treatment Center, they are carefully assessed by a Psychologist and Psychiatrist. In conjunction with Dr. Ball and the treatment team, an accurate diagnosis is made, discarding inappropriate or stigmatizing labels. Dr. William Wirshing, the PCH Psychiatrist, is an expert in psychopharmacology. He assesses each Client’s medication regimen and adjusts their medication usage to a minimal level, when indicated.

In conjunction with individual psychotherapy, we offer somatic experiencing, group therapies such as Dialectical Behavioral Therapy (DBT), anger management, sleep management, and psycho-education. Neurofeedback is also an important adjunct. Holistic therapies including yoga, meditation, acupuncture and massage therapy are also utilized for recovery and healing. Family therapy groups are available which incorporate family members or significant others into the Client’s treatment environment. This can be extremely effective in dealing with personality disorders.